Social Security System (SSS) Edition 04-2012 (printed on the form) 3 pages

SSS Death Claim Application

A beneficiary's claim for the SSS death benefit of a deceased member.

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SSS death claim · SSS Death Claim Application
The official Social Security System (SSS) form, edition 04-2012 (printed on the form) — blank
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SSS death claim (2012) SSS Death Claim Application — page 1 of 3
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SSS death claim (2012) SSS Death Claim Application — page 2 of 3
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SSS death claim (2012) SSS Death Claim Application — page 3 of 3
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Fill this form online Blank PDF from Social Security System (SSS)

What is SSS death claim?

The Death Claim Application is the Social Security System form a beneficiary uses to claim the death benefit of a deceased SSS member, paid as a monthly pension or a lump sum. It covers the member, the member's employment history and dependent children, the claimant, any SSS pension the claimant already receives, and the bank account.

SSS's death benefit page says the claim is filed over the counter at any SSS branch, and that a qualified dependent legal spouse who is registered in My.SSS can also file online. The Death Claim Application is listed among the basic documents, with the death certificate and the other papers SSS asks for.

FileIt asks the questions in order, prints everything in capital letters one digit per box, and fills SSS's own three-page form. You sign it, or give your fingerprints, at the SSS branch.

Who fills it
The beneficiary claiming the death benefit
Filed at
Any SSS branch, over the counter
Type of claim
Social Security, Employees' Compensation (work-related death), or both
Signature
In ink, or right thumb and index fingerprints in front of an SSS employee
Edition
04-2012
Pages
3 (the second is instructions)

Who needs to fill out SSS death claim?

  • The surviving legal spouse of a deceased SSS member.
  • A guardian claiming for the member's dependent children.
  • Other beneficiaries SSS recognises for the deceased member.
  • Families of an employed member whose death was work-related, for the Employees' Compensation benefit.

When to use SSS death claim

  • After an SSS member dies, once you have the registered death certificate.
  • When you file at an SSS branch rather than online.
  • When you also claim Employees' Compensation for a work-related death.

What you need before you start

  • The member's SS number, full name, dates of birth and death, place of death and civil status.
  • The member's employers with the month and year they started and left each one, as far as you know.
  • The member's dependent children's names, dates of birth and addresses, if any.
  • Your own SS number (if any), name, address, date of birth, relationship to the member, TIN and phone number.
  • Your bank, branch and savings account number, or cash card.

What’s on SSS death claim

The 2012 edition has 3 pages. FileIt asks for it in 7 parts:

  1. Part I — The deceased memberClaimant
  2. The member's employment historyClaimant
  3. Dependent childrenClaimant
  4. Claimant's informationClaimant
  5. Part II — SSS pension you already receiveClaimant
  6. Bank accountClaimant
  7. CertificationClaimant

How to fill out SSS death claim, step by step

1 The deceased member

Enter the member's SS number, name, date of birth, date and place of death, the type of claim (Social Security, Employees' Compensation or both) and the member's civil status.

2 Employment history

List the member's employers, latest first, with the period of employment as MM-YYYY. The form has four rows.

3 Dependent children

List up to five children below 21, or over 21 and incapacitated, who are unmarried and not employed, with their dates of birth and whether each is legitimate or illegitimate.

4 Claimant's information

Your SS number if you have one, name, address, date of birth, gender, relationship to the member, TIN, phone number and how you want to be paid.

5 Pension you already receive

Say whether you already receive an SSS disability, retirement or death pension. For a death pension from another member, give that member's SS number and name.

6 Bank and certification

Give the bank, its address and your savings account number. You certify the information and the statements about the children, and sign at the branch.

Common mistakes to avoid

  • Leaving the type of claim blank: tick Social Security, Employees' Compensation, or both.
  • Writing the period of employment as a full date: the boxes take month and year only.
  • Entering the member's SS number in your own SS number boxes.
  • Listing children who are 21 or over and not incapacitated, married or employed.
  • Signing before you reach the branch, when SSS asks for fingerprints in front of its employee.

After you fill it out

Print the form from your FileIt vault and take it to an SSS branch with your IDs, the member's death certificate and the other documents SSS lists.

Sign it, or give your right thumb and index fingerprints, in front of the SSS employee. FileIt does not file the claim.

Keep the acknowledgment stub at the bottom of page 1, and the PDF in the member's folder in your vault.

Fill out SSS death claim online with FileIt

  1. Pick the person. Choose someone from People and FileIt fills in their name, date of birth, address and other details it already knows.
  2. Answer plain-language questions. One part of the form at a time, with the official help text beside each question — 72 fields in all. Your answers save as you go.
  3. Check the live preview. Watch your answers land on the real Social Security System (SSS) form, and let FileIt do any worksheet arithmetic.
  4. Generate the official PDF. FileIt prints your answers into the agency’s own PDF and files it in that person’s folder in your vault.

FileIt fills the form — it never files or submits anything for you. Deliver the finished form to whoever asked for it, the way the form’s instructions say.

Start SSS death claim now — it’s free

SSS death claim: frequently asked questions

Where do I file the SSS death claim?

SSS says over the counter at any SSS branch. A qualified dependent legal spouse registered in My.SSS can also file online.

What is the Employees' Compensation claim?

A separate death benefit when the member's death was work-related. The form lets you claim it with the Social Security benefit.

I don't have an SS number. Can I still claim?

Yes. The claimant's SS number is marked 'if any'.

How many children can I list?

The form has five rows for dependent children.

Can I sign it electronically?

No. You sign at the branch, or give your fingerprints in front of an SSS employee.

Official sources

FileIt is not affiliated with or endorsed by Social Security System (SSS) or any government. This page explains the form in general terms and is not legal, tax or immigration advice. Always read the official instructions, and check that you are using the edition the recipient accepts. Page last reviewed 2026-10-25.

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